Wernicke Encephalopathy and Sleeve Gastrectomy: A Case Report and Literature Review

Abstract

As the number of obese patients increases, as will the number of bariatric procedures. Malabsorptive bariatric procedures have emerged as one of common causes of Wernicke encephalopathy (WE), an acute neuropsychiatric disorder due to thiamine deficiency. However, restrictive procedures such as sleeve gastrectomy (SG) are less prone to cause nutrient deficiencies. WE occurred after SG is an uncommon complication because the main absorptive sites for thiamine are intact after SG. Here, we report a case of WE after SG. With rapid increase in the use of SG for morbid obesity, this case deserves particular attention from clinicians.

Preventing Wernicke Encephalopathy After Bariatric Surgery

“…We identified 118 case descriptions in the published literature [ 9 – 101 ]. The most common bariatric procedure was Roux-en-Y gastric bypass [ 9 – 13 , 15 – 18 , 24 – 63 ], followed by sleeve gastrectomy [ 19 , 64 – 85 ] (see Fig. 1 for an overview on the characteristics of the identified bariatric cases that subsequently developed WE).…”

“…Descriptions of sleeve gastrectomy [ 19 , 64 – 85 ] had a more recent publishing date (median 2014) than papers on Roux-en-Y gastric bypass [ 9 – 13 , 15 – 18 , 24 – 63 ] (median 2006) ( U (85) = 301.5, p < .001), possibly reflecting the increasing popularity of sleeve gastrectomy in the last few years as the bariatric treatment of choice. Furthermore, the gastroplasty cases [ 20 , 86 – 94 ] were older (median 1997) than the Roux-en-Y gastric bypass cases [ 9 – 13 , 15 – 18 , 24 – 63 ] ( U (72) = 96, p < .001) and sleeve gastrectomy cases ( U (34) = 4.6, p < .001).…”

Atypical Wernicke’s encephalopathy without mental status changes following bariatric surgery in an adolescent patient

“…The percentage of weight change reported was between 10% and 35%. 20 patients improved or recovered with supplementation,5–9 19–32 while 1 patient developed Korsakoff syndrome 33…”

Presentation of Wernicke encephalopathy in patient secondary to one anastomosis gastric bypass. Case report and literature review

“…Wernicke's encephalopathy is an acute neuropsychiatric syndrome characterized by nystagmus with ophthalmoplegia, altered consciousness, and ataxia, although this triad is observed in only 16% of the patients 9 . Thiamine is a water-soluble vitamin that acts as a coenzyme in the metabolism of carbohydrates, lipids, and amino acids, and plays an important role in adenosine triphosphate synthesis, maintenance of myelin layers in neurons, and neurotransmitter production 1,9 . Thiamine is absorbed by the proximal small intestine.…”

“…Obesity is a chronic multifactorial disease involving genetic, environmental, and lifestyle aspects, which leads to an excessive accumulation of body fat 1 . The World Health Organization (WHO) considers obesity as one of the rapidly growing metabolic disorders, which is similar to data reported for diabetes 2 .…”